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1. VIOLENCE AGAINST WOMEN & GIRLS:
PREVENTION, SUPPORT & CARE
Geneva 2021
Dr Venkatraman Chandra-Mouli Dr Avni Amin Ms Marina Plesons

2. DEFINITIONS
 Gender-based violence (GBV): Violence directed
towards a woman, because she is a woman, or
violence that affects women disproportionately.
 Violence against women: Any act of gender-based
violence that results in, or is likely to result in
physical, sexual or psychological harm or
suffering to women.
 Intimate partner violence: Behaviour by a
current or former intimate partner that causes
physical, sexual or psychological harm.
 Sexual violence: Any sexual act, attempt to
obtain a sexual act, or other act directed against
a person’s sexuality using coercion, by any person
regardless of their relationship to the victim.

3. RATIONALE1/2
 Gender-based violence against adolescents is an
important problem: Among ever-partnered girls aged
15-19, the lifetime prevalence of intimate partner
violence is 29%.[1] The prevalence of child sexual
abuse worldwide is estimated to be approximately
18% for girls and 8% for boys.[2]
 Gender-based violence against adolescents has major
health & social consequences: It increases girls’ risk of
unintended pregnancies, induced abortion (often
unsafe), the acquisition of HIV and STIs in some
settings, adverse mental health outcomes, & is a risk
factor for unhealthy behaviour during adolescence &
adulthood.[1,3,4]

4. RATIONALE2/2
 Gender-based violence prevention, support & care
programmes have been shown to be effective:
Parenting support programmes, school-based dating
violence prevention programmes, & community based
interventions to build equitable gender norms &
attitudes in boys & girls have been shown to be
effective.[5] Effective programmes incorporate
multisectoral & multilevel action, foster intersectoral
coordination, use longer term investments, repeat
exposure to ideas in different settings over time, place
gender power interplay at the core of the content, &
respond to those who experience violence with
empathy & in a timely manner.[6,7]
 However, laws & policies, prevention strategies &
their implementation, & access to high quality care &
support services need attention: There is much that
needs to be done.

5. HUMAN
RIGHTS
OBLIGATIONS
 States are obliged to prevent and address
violence against women and girls, providing
them with support and care.
 States are obliged to immediately pursue all
appropriate means of eliminating gender-
based violence.

6. KEYCONCEPTS
TO CONSIDER
 Where GBV prevention & response services exist, they are
often implemented on a pilot basis & not scaled up; further,
they are piecemeal and not integrated into existing
platforms. Further intersectoral coordination is weak:
Support and care for adolescent girls who experience IPV &
sexual violence need to be integrated into sexual &
reproductive health, HIV, mental health and adolescent
health programmes & services.[6]
 Many health care providers are not prepared to deal with
GBV, including on the reporting of sexual abuse: Training &
ongoing support to health care providers are imperative to
ensure that care is child-and adolescent centered, age
appropriate, responsive to needs of adolescents & takes into
account their evolving capacity in decision-making about
involving parents and other caregivers.[6,8,9]
 Adolescents often do not seek GBV prevention, support and
care services: Raising public awareness on the signs,
symptoms & health consequences of IPV & sexual abuse, &
on the need, and overcoming stigma is key to changing the
situation.[10]

7. WHO
GUIDELINES
 Responding to children and adolescents who have been
sexually abused: WHO clinical guidelines (2017).
 Responding to intimate partner violence and sexual violence
against women: WHO clinical and policy guidelines (2013).
 WHO guidelines on preventing early pregnancy and poor
reproductive outcomes among adolescents in developing
countries (2011).
 WHO guidelines for the health sector response to child
maltreatment (2019).
 Consolidated guideline on sexual and reproductive health
and rights of women with HIV (2017).

8. COMPLEMENTARY
DOCUMENTSTO
WHO’s
GUIDELINES
 Global plan of action: health systems address violence against
women and girls (WHO, 2017).
 RESPECT women: preventing violence against women,
framework and implementation package (WHO, 2019).
 INSPIRE: seven strategies for ending violence against children
(WHO, 2016).
 Global guidance on addressing school-related gender-based
violence (UNESCO, 2016).
 Sixteen ideas for addressing violence against women in the
context of the HIV epidemic: a programming tool (WHO, 2013).
 What works to prevent partner violence? An evidence overview.
(London School of Hygiene and Tropical Medicine; 2011).
 School-based violence prevention: a practical handbook (WHO,
2019).
 COVID-19 and violence against women: What the health
sector/system can do (WHO, 2020).
 Addressing violence against children, women and older people
during the covid-19 pandemic: Key actions (WHO, 2020).
 Infographics on COVID-19 and violence against women (WHO,
2020).

10. Specific measures
fordelivery of
servicesin the
context of
COVID-19
 Inform adolescents where and how to get care, where
access is possible, through mass media and digital media.
 Sensitize and alert health-care providers, community
workers and support networks to the potential for
increases in sexual and gender-based violence and ensure
they are aware of adolescents’ specific vulnerabilities (e.g.
limited ability to report abuse).
 Strengthen screening and enhance care and support,
including mental health and psychological support for
adolescents.
 Ensure the availability of post-rape care services including
emergency contraception, HIV post-exposure prophylaxis,
and testing and treatment for STIs for adolescents.
 Identify safe houses, shelters or social service referrals for
adolescents at risk of violence in or around their homes.
 Establish help lines or enhance existing help lines for
adolescents to seek help if needed.

11. Considerationsfor
resumptionof
normalservicesin
thecontextof
COVID-19
 Inform adolescents that they can seek care if they have
experienced sexual and gender-based violence and
were unable to do so during periods of confinement.
 Where possible, promote the institutionalization of
good practices in improving accessibility and quality
that were put in place during the period of closures and
disruption.

12. References
1. Global and regional estimates of violence against women: prevalence and health effects of
intimate partner violence and non-partner violence. Geneva: World Health Organization;
2013.
2. Stoltenborgh M, van IJzendoorn MH, Euser EM, Bakermans-Kranenburg MJ. A global
perspective on child sexual abuse: meta-analysis of prevalence around the world. Child
Maltreat. 2011;16(2):79–101.
3. Sumner S, Mercy J, Saul J, Motsa-Nzuza N, Kwesigabo G, Buluma R, et al. Prevalence of
sexual violence against children and social services utilization: seven countries, 2007–
2013. Morb Mortal Wkly Rep. 2015;64(21):565–569.
4. Maniglio R. The impact of child sexual abuse on health: a systematic review of reviews.
Clin Psychol Rev. 2009;29(7):647–657.
5. Lundgren R, Amin A. Addressing intimate partner violence and sexual violence among
adolescents: emerging evidence of effectiveness. J Adolesc Health. 2015;56(1):S42–S50.
6. Global plan of action: health systems address violence against women and girls. Geneva:
World Health Organization; 2016.
7. Arango DJ, Morton M, Gennari F, Kiplesund S, Ellsberg M. Interventions to prevent or
reduce violence against women and girls: a systematic review of reviews. Washington, DC:
World Bank Group; 2014.
8. Responding to children and adolescents who have been sexually abused: WHO clinical
guidelines. Geneva: World Health Organization; 2017.
9. Responding to intimate partner violence and sexual violence against women: WHO clinical
and policy guidelines. Geneva: World Health Organization; 2013.
10.Namy S, Carlson C, O’Hara K, Nakuti J, Bukuluki P, Lwanyaaga J, et al. Towards a
feminist understanding of intersecting violence against women and children in the family.
Soc Sci Med. 2017;184(Suppl. C):40–48.

13. A Regional Perspective
Violence against women and girls:
prevention, support and care
“There is never any excuse for violence. We abhor all violence, of all
forms, at all times”
Dr Tedros Adhanom, WHO Director-General
13

14. The Eastern Mediterranean Region has the second highest prevalence of VAWGs globally, with an estimated
37% of ever-partnered women who have experienced physical and/or sexual intimate partner violence at some
point in their lives. (1) Adolescent girls, young women, women belonging to ethnic and other minorities, and
women with disabilities face a higher risk of different forms of violence. (2)
 Proportion of ever-partnered women and girls aged 15 years and older subjected to physical, sexual, or
psychological violence by a current or former intimate partner in the previous 12 months, by form of
violence and by age (SDG indicator 5.2.1) (3-7):
52% in Afghanistan (2015)
29% in Palestine (2019)
26% in Jordan (2017)
25% in Pakistan (2018)
24% in Egypt (2015)
Key facts about VAWGs from the Region - 1
14
In Afghanistan, almost 90% of women have experienced one form of domestic violence, 52% have
experienced physical violence, and 17% have experienced sexual violence. (8)
In Somalia, 35% of women reported lifetime experiences of physical or sexual IPV and 16% reported
lifetime experience of physical or sexual non-partner violence (NPV) since the age of 15 year. (9)

15. 15
Policy Situation
The EMR has the lowest proportion of countries (53%) with national multi-sectoral plans of
action for violence against women globally. (10)
However, of the 16 countries that responded to a RMNCAH policy survey in the Region, 81%
cited adolescents as a specific group for defined interventions for gender-based violence.
(11)
Likewise, 88% have a law to punish perpetrators of coerced sex involving adolescent girls.
(11)
Key facts about VAWGs from the Region - 2

16.  High rates of child and forced marriages: Women and girls who are married as children
are more likely to experience Gender-Based Violence (GBV). Therefore, there is a need to
strengthen work with traditional institutions, community and religious leaders, and
government actors to systematically address this issue. (12)
 Underreporting: Due to social stigma, women and girls hesitate to report incidents and
believe that “nothing could be done”. They are commonly afraid of further violence from
perpetrators, and do not trust services due to fear confidentiality breech. (13)
 Attitudes and social and cultural norms: Social norms that blame the women for
violence they experience (e.g., because she was out alone after dark, she was not
modestly dressed, she is working outside the home), along with gender discrimination
and stigma, prioritize protecting family honor over the safety and wellbeing of the
survivor and encourage institutional and social acceptance of GBV as normal. (13,14)
Regional challenges - 1
16

17. Proportion of males 15-49 years who consider a
husband to be justified in hitting or beating his wife
AFG:70 (2015), JOR: 64 (2018), PAK: 58 (2018), QAT: 22
(2012)
Proportion of females 15-49 years who consider
a husband justified in hitting or beating his wife
Attitudes towards Gender-Based Violence (15,16)
17
AFG: 78 (2015), JOR: 63 (2018), PAK: 51 (2018),
MOR: 64 (2004), EGY: 46 (2014), SUD: 35 (2014),
YEM: 49 (2013) IRAQ: 31(2018), TUN: 26 (2012),
OMAN: 9.6 (2014), Lebanon: 22 (2009)

18. 18
 Lack of information: There is limited information available to the public regarding the
consequences of GBV and the availability of potential legal and social support services
for the survivors. (14)
 Low availibility of services: Women and girls who experience GBV are likely to seek
Family planning or maternal health services. Therefore, the health sector is one of the
key entry points for ensuring survivors get the care and support they need.
Unfortunately, these services are often not available. For example, a recent survey
showed that only 10% of facilities in Afghanistan are well prepared to address GBV, and
that only a quarter of the 280 health facilities surveyed in 7 provinces had private
examination rooms and only 2% of facilities had a protocol in place for GBV care. (17)
 Numerous humanitarian settings: One in five refugees or displaced women in complex
humanitarian settings has experienced sexual violence. (18) Meanwhile, care services
for women and girls survivors of violence remains one of the least implemented parts of
the Minimum Initial Services Package (MISP).
Regional challenges - 2

19. REGIONAL INITIATIVE 1
Violence against women awareness campaign in Afghanistan (19)
Time period: 2016 and early 2017
Implemented by: Public Legal Awareness Unit of the Afghan Ministry of Justice and two
NGOs (Women for Afghan Women and Voice of Women Organization), with support from
the International Development Law Organization (IDLO).
Setting: The campaign was rolled out across nine provinces (Badakhshan, Balkh, Bamyan,
Herat, Jowzjan, Kabul, Kunduz, Nangarhar and Samangan), including some that posed
significant security challenges, reaching 5000 people.
Aim: The campaign aimed to educate participants on all forms of gender-based violence,
including domestic violence, forced and underage marriage, rape, forced prostitution,
beating, harassment and humiliation.
19

20. (1) By signing a symbolic pledge
banner, students affirmed their
commitment to say ‘NO’ to violence
against women.
(2) Public awareness of citizens’ rights was an
important part of the initiative.
(3) High school teachers were empowered
to raise awareness locally within their
schools.
(4) Local ownership helped ensure the
sustainability and success of the
campaign.
(5) Live drama performances engaged young
audiences on an emotional level.
(6) Community leaders (Mullah and Tribal
elders) were familiarized with
constitutional and religious legal
frameworks to ensure their decisions are
fair and consider the rights of all parties.
REGIONAL INITIATIVE 1, cont.
Violence against women awareness campaign in Afghanistan (19)
20

21. Surveys conducted by the Health Clusters (April-May 2020) to measure health service
utilization by GBV survivors during COVID-19 in Afghanistan, Iraq, and Somalia showed a
45% percent increase in GBV.
The survey’s findings highlighted an increase not only in domestic violence, but also of
sexual violence against girls, along with a concerning upsurge in female genital mutilation
(FGM).
Initiatives have thus been undertaken at the country level to address the continuity of
life-saving services and to establish referral linkages in order to connect survivors and
reach out to women and girls in need of support.
21
REGIONAL INITIATIVE 2
Prevention and response to violence against women and girls in the Region in the
time of COVID-19 (20)

22. In Afghanistan, a guidance note was developed for women's protection centres operating during
the COVID-19 pandemic, in partnership with UN Women. Management support was provided, as
needed.
In Iraq and Lebanon, guidance was produced for both remote and face-to-face health services
for women who may have been subjected to violence, and for updated referral pathways for each
governorate. Online training was conducted on GBV and COVID-19 for frontline workers from the
Ministry of Interior and the Ministry of Defense. Additionally, remote case management was put
in place, with the aim of establishing safe, strong and flexible communication lines with survivors
living in confinement with their aggressors.
In Pakistan, GBV-specialized telemedicine support and health services were implemented in
collaboration with the Institute of Psychiatry in Baluchistan. Additionally, the capacity of health
providers in the country’s high risk/burden provinces was built to support them to integrate GBV
response into their services during the COVID-19 pandemic.
22
REGIONAL INITIATIVE 2, cont.
Prevention and response to violence against women and girls in the Region in the
time of COVID-19 (20)

23. Key messages
I. GBV, and specifically violence perpetrated against women and girls which is largely driven
by deep-rooted gender discrimination, is a significant threat to adolescent health and well-
being in the Region.
II. Health services are critical for mitigating the health impacts of such violence, particularly
to prevent HIV, unwanted pregnancy, STIs, and adverse mental health outcomes.
III. Health services for women and girls survivors remain inadequate in many countries in the
Region, with severe consequences for the health of women and girls.
IV. WHO is intensifying efforts to ensure that violence against women and girls is better
prioritized by the health sector in emergencies and that health partners are equipped with
the technical knowledge needed to respond.
V. WHO encourages donors, UN agencies, and NGOs to step up efforts to integrate services
for women and girls survivors as a core part of their health responses in emergencies,
including for COVID-19.

24. 24
1. WHO Regional Office for the Eastern Mediterranean. WHO to release Arabic version of package on health
system response to violence against women and girls. World Health Organization; c2021. Available from:
http://www.emro.who.int/media/news/who-to-release-arabic-version-of-package-on-health-system-
response-to-violence-against-women-and-girls.html
2. WHO. Respect women: preventing violence against women. World Health Organization; 2019.
3. Central Statistics Organization (CSO); Ministry of Public Health (MoPH); ICF. Afghanistan Demographic and
Health Survey (AfDHS) 2015. Kabul (Afghanistan): Central Statistics Organization; 2017. Available from:
https://dhsprogram.com/pubs/pdf/FR323/FR323.pdf
4. Ministry of Health and Population(Egypt); El-Zanaty and Associates; ICF International. Egypt Health Issues
Survey (EHIS) 2015. Cairo (Egypt): Ministry of Health and Population; 2015. Jointly published by ICF
International. Available from: https://dhsprogram.com/pubs/pdf/FR313/FR313.pdf.
5. Department of Statistics (DOS); ICF. Jordan Population and Family and Health Survey 2017-18. Amman
(Jordan): DOS; 2019. Jointly published by ICF. Available from:
https://dhsprogram.com/pubs/pdf/FR346/FR346.pdf.
6. Palestinian Central Bureau of Statistics. Preliminary results of the violence survey in the Palestinian Society
2019. Ramallah (Palestine): Palestinian Central Bureau of Statistics; 2019. Available from:
http://www.pcbs.gov.ps/Downloads/book2480.pdf.
7. National Institute of Population Studies - NIPS (Pakistan); ICF. Pakistan Demographic and Health Survey
2017-18. Islamabad (Pakistan): NIPS; 2019. Jointly published by ICF. Available from:
https://dhsprogram.com/publications/publication-fr354-dhs-final-reports.cfm
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